HomeMy WebLinkAboutPermit Mechanical 1993-07-01CITY OF OFEGO'V
UOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 fifth Street
Springfield, Oregon 97 417
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0ffice:
INSPECTION LINE:
%
726-3759
726-3769
Job Location: )
Assessors *:Tax Lot #:O)OO O
Ovner:
Address:Phone *:
Cl ty:S tate:ztpt ?1qQ !
Value of llood Stove/Pellet Stove/Insert:
(please circle appropriate appli ance
Preliminary rnspection is 915.00 (prior to instalration of insert)llood stove/Perret/rnsert permit is 915.00 + 910.00 rssuance + g.?5 state surcharge.
Type of Inspection Requested:
Contrac tor:
Address:Phone #:
Ci ty:State:Zipz
Construction Contractors Registration #:Expires:
By signing this permit/application , I agree to call for an inspection(s) as requi red(726-3769), I state that aII in formation on this applicatlon/permit is corr ect andthat I vas provided vith the Ilood Stove Safety inforuration for vood burningappliances and preliminary i nspection standards. I further state that the appliancef am installing meets smoke emission standards as set by the 0regon Department ofEnvironmental Quality or the Federal Environmental Protection Agency and I agree toprovide the testing approval number to the inspector at the time of inspect ion. Ialso understand that if I am requesting a preliminary inspection, the vaII covering
may be d to be removed
1
gnat Date
FOR OFFICE USE
REQUIRED INSPECTI0N(S) : UO0DSTOVE /PELLET/TNSERT
Date of Application:'1
Total Amount Collected: tq OC)
Receipt lf :S G)R
PRELTMINARY Y
Job *:
Checked for Delinquencies:
Issued By:
Checked for Historical Status fi-
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